Acne

Question 1

What are the 4 main processes causing acne?

Answer 1

Increase in sebum excretion rate (SER) Abnormal follicular keratinisation and desquamation (hypercornification) Colonisation with Propionibacterium acnes Inflammation

Question 2

What is ‘Comedogenesis’?

Answer 2

accumulation of stuff in pilosebaceous duct

Question 3

What is acne?

Answer 3

Any disease that begins with a microcomedo

Question 4

What is acne vulgarisms?

Answer 4

a common disease of pilosebaceous unit characterised by comedones, papules and pustules

Question 5

What is the process in which acne develops?

Answer 5

Increase in SER –> Seborrhoea –> ?androgens ?free fatty acids from sebum –> hyperkeratosis of follicle –> abnormal desquamation –> retention keratosis –> microcomedo

Question 6

How does P.aureus affect acne?

Answer 6

thrives in sebum colonises in follicle

Question 7

How does P.aureus cause inflammation?

Answer 7

products of P.aureus interact with host cells, causing inflammation

Question 8

What are open comedones?description

Answer 8

blackheadsa) dilated orifice b) layered keratinous squamaec) P.acnes

Question 9

What are closed comedones?description

Answer 9

whiteheadsundiluted orifice disordered keratinous squamous P.acnes

Question 10

What are the inflammatory lesions involved in acne?

Answer 10

maculespapulespustulesnodulescysts

Question 11

What are the differentials when considering a diagnosis of acne?

Answer 11

acne rosaceaperi-oral dermatitis folliculitis DLEdrug eruption

Question 12

When should you consider an underlying endocrine disorder?

Answer 12

Sudden onset severhirsutism menstrual disturbances

Question 13

Which factors aggravate acne?

Answer 13

occlusive cosmetics/hair productsheat/humidity excessive/vigorous washing manipulation of lesions exogenous medications

Question 14

List some acne subtypes

Answer 14

acne vulgariscystic acne or acne conglobataacne fulminant acne excoriate neonatal acneinfantile acne endocrine acne occupational acne pomade/cosmetic acne drug induced acne tropical acne

Question 15

outline the main ways of treating acne

Answer 15

patient educationantibacterials antibioticsretinoidshormonal topical or systemic medication

Question 16

What is first line in mild /moderate disease?

Answer 16

antibacterials or retinoidslimited use in sensitive skin

Question 17

What are examples of -topical antibacterials used?

Answer 17

benzoyl peroxide azelaic acid

Question 18

What are the pros of using benzoyl peroxide?

Answer 18

no resistance some anti-inflammatory activity increased efficacy with antibiotic

Question 19

What are the cons of using benzoyl peroxide?

Answer 19

irritation bleaching

Question 20

What are the pros/cons of azelaic acid?

Answer 20

no resistance less effective than benzoyl peroxide irritation limits usefulness

Question 21

What are the pros/cons of erythromycin/clindamycin?

Answer 21

well tolerated problems with resistance when used as mono therapy

Question 22

When should systemic antibacterials be used to treat acne?

Answer 22

moderate to severe acneif failure of topical treatment if scarring consider if chest or back is also involvedcombine with topical agents

Question 23

What are the topical retinoids that can be used?

Answer 23

IsoretinoinTretinoinAdapalone

Question 24

What are the main problems associated with topical retinoids?

Answer 24

erythema and irritation photosensitivity teratogenicity

Question 25

What are the main problems associated with topical antibiotics?

Answer 25

resistance limit use to 6 months

Question 26

What are the first line of systemic antibiotics used?

Answer 26

cyclines - doxycycline - lymecycline - tetracycline

Question 27

What are the second/third lines of systemic antibiotics used?

Answer 27

second line = macrolides third line = trimethoprim

Question 28

How can you limit resistance problems when treating acne?

Answer 28

Sue BPOuse others only if necessary combination therapy avoid mixing antibiotic types simultaneously limit duration of treatment maintenance therapy with BPO/retinoid Retreat with same antibiotic

Question 29

What is the mechanism of action of retinoids?

Answer 29

expulsion of mature comedones inhibition of comedone formation anti-inflammatory enhancement of penetration of other agents

Question 30

What are the limitation of retinoids?

Answer 30

teratogenicity erythema and irritation of topical agents photosensitivity

Question 31

How effective is oral isotretinoin?

Answer 31

Fabulously effective - reduced comedogenesis- reduces sebum production - decreases p.acnes and therefore inflammation

Question 32

When is is isotretinoim indicated for use?

Answer 32

- severe acne- active acne with scarring - resistant disease- where rapid relapses on cessation of oral therapy - acne leading to psychological.psychiatric disease

Question 33

How is isotretinoin given as treatment?

Answer 33

treatment usually for 4-6 months total cumulative dose is relevant 22-30% relapse rate

Question 34

When is isotretinoin contraindicated?

Answer 34

contra-indicated in pregnancy/breast feeding effective contraception required (2 methods) through 3 months monthly pregnancy tests

Question 35

What are the side effects of isotretionoin?

Answer 35

Mucocutaneous - dry skin, dermatitis, itching, dry mucosa, epitaxis, skin fragility, hair lossToxicity - increased lipids, deranged liver function, arthralgia/myalgia, disruption of night vision, initial fear of acne

Question 36

What is an example of a hormonal treatment that can be used?

Answer 36

Dianette - variabel tolerance - obvious contraindications - increased risk of venous thromboembolism

Question 37

How are scars treated?

Answer 37

excision laser resurfacing intralesional steroid for keloids dermabrasion microdermabrasion

Question 38

What are the non-inflammatory lesions in acne?

Answer 38

open and closed comedones